Hip Quiz

1. Which muscle has orign at posterior sacrum

2.
3.
4.

5.

and illium and inserts just distal to the greater

trochanter?
The gluteus medius is a prime mover in this hip
motion?
Which one joint muscle extends the hip?
The bony landmark of the femur located
medially and posterior on the proximal end, it is
illiopsoas attachment.
What muscles laterally rotate the hip?

Knee Joint

Knee Joint
One of the most frequently injured joints in

the body.
Largest joint in the body and a synovial hinge
joint.
It mainly flexes and extends, but it does have
a rotational component as well.

Knee Joint
Patellofemoral joint- articulation between the

patella and the femur.

Patellas main job is to increase the

mechanical advantage of the quad muscle
and protect the knee joint.

Knee Joint
With a longer moment arm, there is more

angular force. With a shorter moment arm,

the force would be more directed to the joint
than the tendon.

Knee Joint
Q-angle- angle between the quadriceps

muscle and patellar tendon. It ranges from

13-18 degrees in normal individual in knee
extension. It is greater in females. Due to
our wider pelvis.
Lets graph our q-angles.

Knee Joint-Landmarks
Intercondylar eminence- double pointed

prominence on the proximal surface of the

tibial plateau.

Knee Joint-Landmarks
Medial and Lateral Condyle of the tibia-

proximal end of the bone just below the tibial

plateau.

Knee Joint-Landmarks
Tibial Plateau- proximal end including the

medial and lateral condoyles and

interdcondylar eminance. The top of the tibia.

Knee Joint-Landmarks
Tibial Tuberosity- large

projection at the proximal

end and anterior side,
where the patellar tendon
attaches.

Knee Joint-Landmarks
Patella- triangular shaped seasmoid bone

within the quadriceps tendon.

Knee Joint Structures

Cruciate Ligaments- within the joint capsule,

they cross. They are intracapsular ligaments

and named for their attachment on the tibia.

Knee Ligaments
Anterior Cruciate Ligament- It attaches to the

anterior side of the tibia just medial to the

medial meniscus. It attaches to the posterior
side of the femur. It prevents anterior
translation of the tibia on the femur.

Knee Ligaments
Posterior Cruciate Ligament- attaches to the

posterior side of the tibia. It attaches to the

anterior femur and prevents posterior
translation of the tibia on the femur.

Knee Ligaments
Medial Collateral

Ligament- Attached
to the tibia and
femur on the medial
side of the knee
joint. Also attached
to the medial
meniscus, so injury
to one can result in
injury to both.

Knee Ligaments
Lateral Collateral Ligament- attached from

the femur to the fibula on the lateral side of

the knee. Shorter and stronger than the
MCL.

Knee Joint Structures

Meniscus- medial and lateral meniscus are

two half moon, wedge shaped fibrocartilage

located on the superior tibia. They provide
shock absorption in the knee. Medial is more
often torn.

Knee Joint Structures

Bursa- fluid filled sac that reduce friction in a

joint. The knee has 13 due to all the tendons

and their vertical line of pull against bony
area.

Knee Structures
Popliteal space- area behind the knee that

contains important nerves and blood vessels.

The hamstrings and gastronemius make up
the diamond shaped boarder.

Knee Structures
Pes Anserine muscle group- made up of

Sartorius, Gracilis and semiTendinosus.

(SGT). They come from posterior to medial
anterior knee, there is a bursa under the
insertion.

Quiz #3
1. Name the three muscles that attach at the

medial anterior knee. They are know as the

Pes Anserine group and their abbreviation is
SGT.
2. What does ACL stand for?
3. What is the shock absorber of the knee?

Medial Collateral Ligament Sprain

Causes are blow to the

lateral knee or high speed

twisting motion.
Classified with three grade
scale based on signs
and symptoms
MOI is important

Medial Collateral Ligament Sprain

Signs and Sx

Limited ROM
Tenderness at either
insertion of MCL or
along ligament length.
Various levels of pain
and laxity to medial
knee

Special Test
Valgus Stress Test

Treatment

RICE and protect

Ice and Interferential
Straight leg
strengthening initially.
Immobilize if
necessary

Lateral Collateral Ligament Sprain

Not as common as the

MCL sprain.
Caused by a medial force
to the knee joint or a
twisting.
Classified with 3 grades
like any other sprain.

Torn Anterior Cruciate Ligament

Can be a contact or non-contact injuy.
Can be a blow to the lateral or posterior knee.
Non-contact loaded

knee in combined
flexion, valgus
and rotation of the
tibia on the femur.

Torn Anterior Cruciate Ligament

Signs and Sx

Hear or feel a pop

Rapid effusion
Buckling of the knee
Guarding will occur
quickly so special tests
need to be done within
5 minutes of injury

Treatment

Splinting, ice,
compressive wrap and
crutches.
Surgery for a ACL tear
in necessary
Not typically seen with
grades, but they do
occur
MRI is confirmation for
diagnosis

Torn Anterior Cruciate Ligament

Female ACL injuries happen 4-6x more often

than male ACL injuries.

This is due to

Biomechanical factors- use more quad than

hamstring. Land flat footed-dont know how to
jump
Hormonal influences-ligament may loosen
during cycle
Anatomic risk factors-Angle of the hips relative
to knees.

Knee Muscles
Popliteus- muscle responsible for unlocking

the knee or initiating knee flexion. It is on the

posterior side of the knee in the poplitial
space deep to the gastrocnemius.

Knee Muscles
Vastus lateralis- spans the quad laterally,

starts on the linea aspera and joins with the

others at the patellar tendon.

Knee Muscles
Vastus Intermedialis- deep to the

rectus femoris arises from the

anterior surface of the femur, it
blends with the other vasti
muscles along its length. All
extend the knee, only the rectus
flexes the hip. Why?

Knee Muscles
Rectus Femoris-

originates on inferior
illiac spine and decends
down the center
of the thigh, most
superficial muscle
of quad.

Meniscus Tear
Meniscus are cushions

in the knee joint that

help make it more
stable.
Medial meniscus is
attached to posterior
and medial side, it is
more often injured.
Lateral meniscus is
more freely moving,
less often injured.

Meniscus Tear
Causes of injury

Twisting of knee when meniscus gets trapped.

When the ligaments are torn, they are attached.
As people age the rubbery meniscus fray

Meniscus Tear
Signs and Sx
Popping, locking,
giving way of the knee
Pain in injury area
General knee swelling

Osgood-Schlatter
The femur is growing faster than

the quad muscle and creates a

traction on the tibial tuberosity
where the patellar tendon
attaches.
Affects males age 12-16
Affects females age 10-14

Osgood-Schlatter
Signs and Sx

Pain and swelling over tibial tuberosity

Increase pain and swelling with activity
Weakness of quadriceps
Visible lump
Pain to touch

Osgood-Schlatter
Treatment

Manage pain swelling and flexibility

Stretch 4x daily-emphasis on hamstrings
Avoid knee extension, squats, power clean
and plyo
Do body weight squats, SLR, hamstring curls
and calf raises.
Wear knee brace if needed.

Patellafemoral Problems
One of the most

challenging knee injuries

for both athlete and
health care provider.
Typical complaint is pain
in front of the knee
(behind the knee cap),
with gradual onset.
The knee may give way
and have a grinding
noise.

Patellar Tendonitis
High force repetitive

injury usually a result of

jumping and/or abrupt
change of direction.
AKA jumpers knee

Patellar Tendonitis
Signs and Sx:

Anterior knee pain

inferior to patellar
tendon
Small amount of
swelling

Treatment

Special TestsTap Test

Clarks Sign

Modified activity to
decrease impact
Stretch Quads
Ice after
Massage/US before
Brace and Tape

Knee Muscles
Vastus medialis- also comes from the linea

aspera and spans the thigh medially and

joints with quads at patellar tendon.

Knee Muscles
Semitendinosus muscle- longer and narrower

distal tendon that moves to the anterior tibia

with the grasillis and sartoris after spanning
the posterior medial thigh.

Knee Muscles
Semimembranosus muscle- runs down

medial side of the thigh deep to the

semitendinosus muscle and attaches to the
medial condyle of tibia.

Knee Muscles
Biceps Femoris- has two head and runs down

the thigh laterally on the posterior side. The

long head starts of the ischial tuberosity, the
short head on the linea aspera. Which head
flexes the knee and extends the hip?